Frequency and Predictors of Traumatic Encephalopathy Syndrome in a Prospective Cohort of Retired Professional Athletes

Abstract

Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, p = 0.087), number of concussions (OR = 1.020, p = 0.532), number of concussions with loss of consciousness (OR = 1.141 p = 0.188), and years playing professionally (OR = 0.976, p = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, p < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.

A systematic review on the risk of neurodegenerative diseases and neurocognitive disorders in professional and varsity athletes

“…After selection based on the pertinence and relevance to the topic of the review, 11,191 records were excluded, leaving 47 articles meeting the selection criteria. The full texts of the selected articles were assessed for inclusion, and 30 further articles were excluded as 3 were case reports [17,19,45], 1 review [46], 1 reported participation in sports as a leisure activity [47] 2 reported data only on an overall measure of physical activity [48,49] 2 included only athletes who had ≥ 1 head/brain injury [50,51] 8 did not report any measure of risk of NDs and/or NCDs [20,[52][53][54][55][56][57][58] and 13 were already included in the 2016 review [59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review

“…The majority of research surrounding sleep and mental health in sport has previously focussed on competing athletes, with little focussed on retired athletes. Post-retirement research is saturated by an emphasis on comorbidities, such as concussion history and subsequent chronic traumatic encephalopathy ( Kerr et al, 2012 , 2014b ; Didehbani et al, 2013 ; Hart et al, 2013 ; Strain et al, 2013 ; Iverson, 2014 ; Hutchison et al, 2018 ; Hind et al, 2021 ; Schaffert et al, 2021 ), and obesity ( Hyman et al, 2012 ; Churchill et al, 2018 ). Further, this research is often limited to contact sport athletes, recruiting male dominated samples.…”

“…While there has been a considerable amount of research separately examining sleep and mental health problems in current athletes ( Gulliver et al, 2014 ; Cheek et al, 2015 ; Kong and Harris, 2015 ; Rao and Hong, 2016 ; Swinbourne et al, 2016 ; Kilic et al, 2017 ; Malhotra, 2017 ; Thornton et al, 2017 ; Tuomilehto et al, 2017 ; Foskett and Longstaff, 2018 ; Castaldelli-Maia et al, 2019 ; Asplund and Chang, 2020 ; Caia et al, 2020 ; Timpka et al, 2021 ; Costa et al, 2022 ), almost none has examined the two areas together. Furthermore, although there is some research on mental health problems in retired athletes ( Kerr et al, 2014a ; Gouttebarge et al, 2016 ; Kilic et al, 2017 ; Fernandes et al, 2019 ; Mannes et al, 2019 ; Esopenko et al, 2020 ), little is known about mental health or sleep problems outside of comorbid conditions (i.e., concussion history, obesity) in ex-contact sport athletes ( Hyman et al, 2012 ; Kerr et al, 2012 , 2014b ; Didehbani et al, 2013 ; Hart et al, 2013 ; Strain et al, 2013 ; Iverson, 2014 ; Churchill et al, 2018 ; Hutchison et al, 2018 ; Hind et al, 2021 ; Schaffert et al, 2021 ). This is despite current and former athletes being susceptible to both sleep and mental health disorders ( Gouttebarge et al, 2019 ).…”

Effect of traumatic brain injury on mild behavioral impairment domains prior to all‐cause dementia diagnosis and throughout disease progression

“…In patients with dementia, TBI may influence cognitive and behavioral outcomes, 8 impacting quality of life and clinical diagnoses. 9 , 10 Perhaps due to underlying network dysfunction and/or the introduction of region‐specific vulnerabilities to neurodegeneration, growing evidence suggests that TBI affects phenotypes of neuropsychiatric symptoms (NPS) during progression to all‐cause dementia. 8 , 11 Importantly, NPS precede dementia diagnosis in many patients; 11 however, some research suggests that patients with TBI history (any severity) may have an earlier onset of anxiety symptoms and an elevated risk of apathy, motor disturbances, and disinhibition compared to those without.…”

“…6,7 In patients with dementia, TBI may influence cognitive and behavioral outcomes, 8 impacting quality of life and clinical diagnoses. 9,10 Perhaps due to underlying network dysfunction and/or the introduction of region-specific vulnerabilities to neurodegeneration, growing evidence suggests that TBI affects phenotypes of neuropsychiatric symptoms (NPS) during progression to all-cause dementia. 8,11 Importantly, NPS precede dementia diagnosis in many patients; 11 however, some research suggests that patients with TBI history (any severity)…”